ACOG changes Pap Smear guidelines

TYLER, TX (KLTV) - With more and more merging information about HPV, as well as the advent of its vaccine, it has prompted a reassessment of Pap Smear and other gynecologic screening guidelines. In the May issue of Obstetrics and Gynecology, the American College of Obstetricians and Gynecologists (ACOG) released a committee opinion with new screening recommendations.

Recommendations on when to initiate and terminate routine cytology screenings are based upon age, but may differ with various exposures and risk factors.

For women under 21 years old, whom have never been sexually active, there is no need for a Pap Smear, pelvic exam or STD testing. If sexual activity has begun, then ACOG recommends that a Pap Smear be obtained within 3 years of onset and annually thereafter. Routine pelvic exam should only be performed as indicated by patient's history.

For women 21-29 years old, ACOG suggests an annual pelvic exam with Pap Smear. Sexually active adolescents should be screened for gonorrhea and Chlamydia; sexually active women 25 and under should be tested for Chlamydia. Chlamydia and gonorrhea may be tested by urine-based screening and does not require speculum exam unless a Pap Smear or visual inspection of the vaginal vault is indicated.

ACOG further recommends tat sexually active women aged 19-64 should be screened for HIV.Pelvic examinations are only indicated in girls aged 13-18 years when medically indicated. Such histories or complaints might include menstrual irregularities, vaginitis, pelvic pain, an STD and pelvic mass.

For women aged 30-64, ACOG recommends annual Pap smear with pelvic examination. After 3 normal exams, however, screening may be reduced to every 2-3 years. (This is only if the patient has never had CIN 2 or 3, is not immune-compromised or HIV-positive, and has not been exposed to diethylstilbestrol (DES) in utero.

Women 65 and older should undergo routine pelvic examinations. Pap Smears may be eliminated if the woman has had 3 or more negative tests consecutively; no abnormal tests in the previous 10 years; no history of cervical cancer; no DES-exposure; is HIV negative and has a normal immune system; and has no other risk factors for STDs. (One risk factor is the presence of a new sexual partner in the last 10 years.) This history should be reviewed at each annual exam.

It is also reasonable to discontinue speculum and pelvic exams in asymptomatic women whom have had a total hysterectomy and bilateral oophorectomy for benign indications. Annual exam of the external genitalia should continue.

Exams and screenings may also be discontinued when a woman's age or health status would preclude her from treating any condition that the studies might reveal.

Ultimately, however, she should discuss the screening schedule that most fits her medical needs and history.

AGE

PAP SMEAR

PELVIC EXAM

STD TEST

HIV TEST

Adolescent

Within 3 yrs of onset of sexual activity

Only if indicated by history or symptoms

Gonorrhea and Chlamydia annually after onset of sexual activity

Annually after onset of sexual activity

21-29

Annually (Start at 21 if not sexually active)

Annually

Under age 25, Chlamydia

Annually after onset of sexual activity

30-64

Annually; After 3 negative Paps, no history of CIN 2 or 3; no history of DDES exposure; normal immunity then every 3 years

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